Clinical characteristics and surgical strategy of glomus tympanicum tumors

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2023 Mar 28;48(3):397-403. doi: 10.11817/j.issn.1672-7347.2023.230206.
[Article in English, Chinese]

Abstract

Objectives: To summarize the clinical characteristics of glomus tympanicum tumors, and to explore the surgical methods and the strategy for auditory protection.

Methods: Ten cases (ears) of glomus tympanicum tumors were collected from the Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University from August 2014 to February 2022. All patients underwent endoscopic or microscopic surgery to achieve total removal of the tumor, followed up for 3 months to 8 years. We summarized and analyzed its clinical characteristics, compared the preoperative and postoperative hearing levels of patients, and made a retrospective summary of the surgical methods and the strategy for auditory protection.

Results: Ten patients were all female at (49.50±8.00) years old. Their medical history ranged from 15 days to 6 years. Seven patients complained of pulsatile tinnitus, and 80% (8/10) of the affected ears suffered different degrees of hearing loss. According to the modified Fisch & Mattox classification of glomus tympanicum tumors, 3 ears (30%) of 10 ears were A1, 2 ears (20%) were A2 and 5 ears (50%) were B1. In all 10 cases (ears), hearing was improved in 3 cases, bone gas conductance was maintained in 6 cases, and hearing was slightly decreased in 1 case. The difference of bone gas conductance was 0-10 dB in 7 cases (ears) after operation, and 10-20 dB in 3 cases (ears). There was no significant difference in the average air conduction hearing threshold, bone conduction hearing threshold and air-bone conduction difference between before and after operation (all P>0.05). All cases had no postoperative complications, and the external auditory canal and the incision behind the ear healed well. There was no recurrence after follow-up.

Conclusions: Glomus tympanicum tumor is easy to bleed, so it is a challenge for total tumor resection and hearing function protection during operation. For type A and type B1 tumors, they can be completely removed under the condition of keeping the tympanic membrane and the ossicular chain. At the same time, the postoperative hearing function can be preserved, and even the hearing can be improved.

目的: 总结鼓室体瘤临床特征,探讨手术方式及入路选择以及术中听觉保护的策略。方法: 收集中南大学湘雅医院耳鼻咽喉头颈外科2014年8月至2022年2月确诊为鼓室体瘤的10例(耳)患者的临床资料,全部患者均接受内镜或显微镜手术实现肿瘤全切,术后随访3个月~8年;结合文献分析归纳其临床特征,比较患者术前、术后听力水平,对手术方式及入路选择、听觉保护等手术策略进行回顾性总结。结果: 10例患者均为女性,年龄(49.50±8.00)岁,病史15 d~6年,7例主诉为搏动性耳鸣,80%(8/10)患耳有不同程度的听力下降。根据改良版Fisch & Mattox鼓室体瘤分型,10例术耳中3耳为A1型(30%),2耳为A2型(20%),5耳为B1型(50%)。全部10例(耳)中3例术耳听力较术前提升,6例术耳气导维持术前听力,1例术耳听力较前稍下降。7例(耳)术后骨气导差为0~10 dB,3例(耳)骨气导差为10~20 dB。术前、术后的平均气导听阈、骨导听阈、气骨导差的差异均无统计学意义(均P>0.05)。所有患者术后均无并发症发生,术后外耳道及耳后切口均愈合良好。术后随访均无复发。结论: 鼓室体瘤因极易出血,在手术中同时兼顾肿瘤全切和听功能保护极具挑战性。对于A型及B1型鼓室体瘤,手术中可以争取在保持鼓膜完整、保留听骨链的前提下彻底去除肿瘤,并同时保留术后听功能,甚至较术前听力有所提高。.

Keywords: ear endoscope; glomus tympanicum tumors; hearing; ossicular chain.

MeSH terms

  • Adult
  • Endoscopy
  • Female
  • Glomus Tympanicum Tumor* / complications
  • Glomus Tympanicum Tumor* / pathology
  • Glomus Tympanicum Tumor* / surgery
  • Humans
  • Middle Aged
  • Postoperative Complications
  • Retrospective Studies
  • Treatment Outcome